Blood pressure worry - going for 2 wisdom teeth extractions on Monday

[mouthsewnshut]

I am going to have 2 wisdom teeth removed on Monday, at the dental access centre. I am going to have IV sedation, they use titrated midazolam. When I went for my assessment, my BP went really high, like 172/96 and 176/104 (revised, I just checked my notes), I was very stressed. The dentist was worried (so was I tbh!) and wrote to my GP about this as she was not happy to go ahead with the procedure and sedation with my BP at that level.

My GP surgery gave me a home monitor, and I had to send two readings a day (best of 3) for a week. I have seen my GP since and she is not worried about my BP as my average is 129/76.

But I was just reading that high BP can lead to complications like stroke or heart attack during extractions. Won't my BP go down with the sedation? the dentist doesn't want me to take diazepam (which I have for anxiety and panic disorder) on the day. Would they call off the procedure if my BP spikes again on Monday morning or would they just sedate me and let my BP drop. Is there anything I can do the day before and on the morning to keep my BP down?

I have been having nightmares about this. I am not only terrified of the procedure itself but the whole grimness afterwards, I am just looking forward to one or two weeks later when it's settled. And I have the added worry of the BP issue which is probably not helping

Any help, tips and reassurance would be appreciated. Thanks!

 

[essella]

I have exactly the same fear / concern. I'm due to have sedation tomorrow (Thursday). Terrified also. Hope someone comes along soon who can answer this for you.

 

[mouthsewnshut]

@essella Oh I want to wish you the best for tomorrow. Please let us know how it goes. I hate this as you must do too, it's an additional worry on top of everything which we could really do without. I wasn't aware of the BP thing before the pre-assessment in October. Strange thing is, I went to the nervous patients clinic locally back in 2015, and they never checked my BP. The dentist tried gas and air, which did nothing at all, but while I was trying it, she asked me if I'd let her take my tooth out and I wasn't able to say yes. I am sure my BP was way higher then, I was (had been) in tears all day, and in the chair, the gas and air only just managed to stop me crying, but that was as much effect as it had on me, which is why I was later referred to the IV sedation clinic. What could have happened then if she'd gone ahead with it.

 

[Gordon]

But I was just reading that high BP can lead to complications like stroke or heart attack during extractions. Won't my BP go down with the sedation

Yes your BP will go down with the IV, but the worry is when it bounces back up again as the IV wears off. The theory is that the body becomes sort of accustomed to the high BP but when it goes down things sort of relax and then a sudden rise again can cause something to "let go". It's probably not true but there's absolutely no way to find out

I'd be reasonably OK with a patient having a small premed of Diazepam before the IV if that got things under control, so it sounds like you need referred to a more experienced sedationist if it happens again.

What could have happened then if she'd gone ahead with it.

Nothing. It's the rebound effect that's the worry. There's no need to take BP before using gas and air, it doesn't really affect the BP.

 

[essella]

Now I"m worrying about this rebound effect...if I have high BP because of extreme nerves...and not because I usually have high bp...will the rebound thing still happen?

Also...if the dentist tells me to breathe because I've forgotten, what if I don't do what he asks - will they have an oxygen mask there?

 

[mouthsewnshut]

@essella The dentist I am seeing has told me that they might give me oxygen during the procedure if I need it, so if you are nervous, ask them about it before you get sedated.

 

[mouthsewnshut]

@Gordon from what I read, it seemed the consensus was that hypertension increased the risk of complications regardless of sedation? Like the cutoff is generally 180/110. I didn't read anything about rebound hypertension, so thanks for the explanation. I am also worried about the car ride back home (about an hour drive) afterwards. I hope I don't feel sick - yes that is another of my phobias that's come and ruined my sanity.

 

[mouthsewnshut]

@Gordon also is rebound hypertension less likely in someone with usually normal BP?

 

[Gordon]

Now I"m worrying about this rebound effect...if I have high BP because of extreme nerves...and not because I usually have high bp...will the rebound thing still happen?

No. It's the chronic exposure to high BP that's the issue.

Also...if the dentist tells me to breathe because I've forgotten, what if I don't do what he asks - will they have an oxygen mask there?

Yes, there is always oxygen present. It's not likely that you'll forget to breath though.

 

[essella]

A quick update. . .unfortunately I was unable to go ahead with the IV sedation today as I had a massive panic attack in the waiting room beforehand. The dental nurses and dentists were amazing, and very kind and understanding. It's obvious now that I can't even manage the extractions by IV Sedation, and they're referred me to the hospital for the extractions to be done under GA. Tbh I think it's the only way I'll be able to have them done. I'm booked in for a filling with the same dentists next week, and I'm ok with that, they're great dentists and very patient and understanding. Not saying I won't be a bit nervous cause I will, but nothing like on the level of my nerves today. It's just extractions that I don't seem to be able to handle at all.

 

[mouthsewnshut]

@essella oh no! I am so sorry to hear I am worried that same will happen to me, it's mad, I am panicking about panicking beforehand. I was supposed to have this done last week, but they rang me to say my appointment was cancelled because the sedation nurse was sick, so I had been preparing mentally for this but then it was cancelled. I understand it's not her fault but I have to go through the preparation again.

 

[Gordon]

It's obvious now that I can't even manage the extractions by IV Sedation, and they're referred me to the hospital for the extractions to be done under GA. Tbh I think it's the only way I'll be able to have them done. I

That's a shame, but these things happen, don't worry about it. Always a chance for a bit of paperwork and an extra coffee for the IV team

 

[pam640]

@essella How did the extraction go? Give us details.